Function-based Practice: The Rifton Support Station

by Nancy Doran, OT

Nancy Doran, OT is employed at William S. Baer School, of the Baltimore City Public School System, which provides education and therapeutic services for approximately 170 students aged 3-21 with severe multiple disabilities and health impairments.

As an Occupational Therapist, I view toileting as a functional life skill, not as an interruption to the day. The product that makes this possible is Rifton’s Support Station.

For each of the more than twenty students on my caseload, I incorporate a toileting objective on their IEP. And for those students using the Support Station, I myself will work with them once a day for their toileting routine.

I never place our students in a horizontal position on a changing table for hygiene care. It is demeaning to the children, especially the older ones, to have them lying down on a changing table like a baby with their legs up in the air.

Before Rifton’s Support Station, I provided hygiene care and toileting by having my students lean forward on a padded table. Getting the students to hold on while leaning up against this table was very challenging. That’s why the Support Station means so much to me.

Rifton began the design work on the Support Station based on input from our location. They came to our school site to see how we did hygiene care for our larger students, and to understand what the needs were. Rifton incorporated our recommendations: the Support Station is very good and has many advantages.

First, there is the adaptability of the device: you can adjust it to any height to accommodate students with a wide variety of height ranges. The trunk board that the student leans on can be easily adjusted in angle as well. The fact that it swivels is helpful: once you have a child leaning against it you can then can swivel them and put them onto the toilet, depending how you have positioned the Support Station in the bathroom.

The shape of the trunk board is like an hour glass, so there is room for the student to comfortably put their arms down. Or there is the option of handholds, for children to assist in the transfer. Additionally, the support strap can be used if the child has fluctuating muscle tone because it secures the child while you manage their lower extremities, bring their clothing down or back up, or get them ready to sit on the toilet.

I use the Support Station for any student age 10 or older who has limited to almost no weight bearing. Many have cerebral palsy or other diagnoses where they are in a wheelchair and have spasticity or fluctuating muscle tone. These children typically cannot walk but they may be able to stand supported in a dynamic stander or a Pacer with the hip positioner underneath them for support.

As our students get older and larger, it becomes more important that they do not remain sitting in their wheelchairs all day every day, and then be placed in a lying down position for hygiene care. In this scenario, they have no opportunity to exercise or improve their abilities. That’s where Rifton’s Support Station comes in. It is very successful with exactly these students. With consistent use they get accustomed to the procedure and they begin to participate.

With the Support Station, they can get in and out of their wheelchairs easily. I even do it with students that are tube-fed; they can rest their trunk in a prone position, and it doesn’t interfere with the tubing at all. So, with the Support Station we are seeing increased functional participation for students who are large and with limited weight bearing. With consistent use, the Support Station is preventing our students from having to sit in their wheelchairs all day, and this regular practice can carry over into improvements in getting out of their wheelchair into a Pacer, or out of their wheelchair into a classroom chair.

We’re looking at toileting as an opportunity, not as an interruption. I have seen them make gains in their pull-to-stand ability, with pulling themselves up, as well as in their sit-to-stand ability, building leg strength. Of course it is not possible to exactly measure the gains, or to attempt to prove that their muscles are stronger without an actual EMG study. But I am convinced that any activity done regularly can transfer into a motor skills improvement.

For one of my students, Angelica, we used the Support Station as a transfer aid to the toilet. We had it set up so the Support Station trunk board would swivel her around and she could sit on the toilet. Because I would see her regularly after lunch for her routine, as long as I was there at the right time, I’d save a dirty diaper, which was great. Hers was a real success story. Training our students to regularity in performance with toileting can be possible with dedicated time and effort. Consistency is the key.

When we think about our adolescent students moving on into adulthood, perhaps two of the biggest barriers to increased participation in society are: difficulty with transfers, and the issue of toileting. The Support Station addresses both of these, not only as an aid that makes each toileting episode easier, but also as a tool for the possibility of improving sit-to-stand strength and even training toileting continence with consistency and regularity.

Once our students graduate beyond the school setting, I personally think the Support Station should be available in the adult centers as well. As this product is used more and more, and all the benefits are experienced, it will continue to be a life-changing product for our population of students.

 

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The William S Baer School is a MOVE Model Site. The MOVE International organization is developing a toilet-training program to be made available this summer (2009). For more information, contact www.move-international.org.